Controlled Drinking: Is Moderation Possible or Should You Quit Completely?

Controlled drinking is possible for some people, but understanding the factors that predict success helps you make an informed decision about your approach.

What You'll Discover:

• What controlled drinking actually means in practice.

• The debate between abstinence and moderation approaches.

• Who can realistically achieve controlled drinking.

• How to attempt controlled drinking effectively.

• Warning signs that moderation isn't working for you.

• How medication can support a moderation goal.

• When abstinence may be the better choice.

According to the National Institute on Alcohol Abuse and Alcoholism, not everyone with alcohol problems needs to achieve complete abstinence. Some people successfully reduce their drinking to moderate, non-problematic levels. Understanding whether this is realistic for your situation helps you choose the right goal.

This article examines controlled drinking honestly, including who it works for, who struggles with it, and how to increase your chances of success.

What Controlled Drinking Actually Means

The first thing to know is that controlled drinking isn't simply "drinking less." It means establishing and maintaining specific limits on your alcohol consumption over time.

Controlled drinking typically involves:

• Setting a maximum number of drinks per occasion (usually 1 to 2)

• Setting a maximum number of drinking days per week

• Never exceeding these limits regardless of circumstances

• Having no difficulty stopping once you've reached your limit

• Not experiencing negative consequences from drinking

The NIAAA defines low-risk drinking as up to 1 drink per day for women and up to 2 drinks per day for men, with some alcohol-free days each week. Controlled drinking means consistently staying within these guidelines.

Something to consider is that controlled drinking requires sustained effort. It's not a passive state but an active practice of setting and maintaining limits.

The Abstinence vs Moderation Debate

For decades, abstinence was the only officially recognized goal for people with alcohol problems. Programs like AA insisted that alcoholics could never safely drink again. Anyone who tried moderation was seen as in denial.

This view has shifted. Research now shows that some people with mild to moderate alcohol problems can successfully return to controlled drinking. The medical community increasingly recognizes that treatment goals should be individualized.

So, why does the debate continue? The short answer is that moderation works for some people but not others, and predicting who will succeed isn't always straightforward. People who fail at moderation often do better with abstinence. But requiring abstinence as the only option prevents some people from seeking any help at all.

For that reason, harm reduction approaches have gained traction. These focus on reducing the damage from drinking even if complete abstinence isn't achieved. Any reduction in heavy drinking produces health benefits.

Who Can Successfully Moderate

Research has identified factors that predict success with controlled drinking versus factors that suggest abstinence is more appropriate.

Factors associated with successful moderation:

• Shorter drinking history

• Less severe alcohol dependence

• No history of multiple failed attempts at moderation

• Strong social support

• Stable life circumstances (housing, employment, relationships)

• No physical dependence (no withdrawal symptoms)

• Younger age at the time of intervention

• Lower genetic risk for alcoholism

Factors that suggest abstinence may be better:

• Long history of heavy drinking

• Severe alcohol dependence

• Previous failed attempts at controlled drinking

• Physical withdrawal symptoms when not drinking

• Alcohol-related health problems (liver damage, etc.)

• Strong family history of alcoholism

• Co-occurring mental health conditions

• History of alcohol-related consequences (DUI, job loss, relationship problems)

If it seems like people with milder problems are better candidates for moderation, that's because they generally are. The more severe your alcohol issues, the less likely controlled drinking will work long-term.

How to Attempt Controlled Drinking

If you want to try controlled drinking, approaching it systematically increases your chances of success.

Step 1: Set specific, measurable limits

Vague intentions don't work. Define exactly:

• Maximum drinks per occasion (typically 1 to 2)

• Maximum drinking days per week (typically 2 to 3)

• Situations where you won't drink at all

Step 2: Track your consumption

Keep a record of every drink you have. Note the date, time, amount, and circumstances. This provides objective data on whether you're meeting your limits.

Step 3: Identify high-risk situations

Recognize contexts where you tend to exceed your limits. These might be specific social situations, emotional states, or times of day. Plan how to handle these situations differently.

Step 4: Build in accountability

Tell someone about your limits. Having another person aware of your goal provides motivation to stay on track.

Step 5: Set a trial period

Give yourself a defined period, such as three months, to evaluate whether controlled drinking is working. Be honest in your assessment at the end.

Step 6: Have a backup plan

Decide in advance what you'll do if moderation isn't working. This might mean trying abstinence, seeking additional support, or trying medication.

Warning Signs That Moderation Isn't Working

Many people attempt controlled drinking and initially succeed, then gradually drift back to problematic patterns. Recognizing warning signs early helps you adjust your approach.

Signs to watch for:

• Frequently exceeding your stated limits

• Making exceptions that become regular occurrences

• Spending significant mental energy thinking about drinking

• Feeling irritated or deprived by your limits

• Hiding or minimizing your drinking from others

• Experiencing negative consequences despite drinking "less"

• Needing to set increasingly strict rules to maintain control

• Regularly renegotiating your limits with yourself

Something to consider is that struggling with controlled drinking doesn't mean you've failed. It means you've gathered important information about what works for you. Many people who try moderation and find it difficult ultimately do better with abstinence.

Our article on do I have a drinking problem can help you evaluate your situation.

How Medication Supports Moderation

Naltrexone is an FDA-approved medication that can make controlled drinking significantly easier. It reduces cravings and the rewarding effects of alcohol, making it easier to stop after one or two drinks.

So, how does naltrexone help with moderation? The medication blocks opioid receptors in the brain. When you drink with naltrexone in your system, you don't get the same pleasurable "buzz." This makes it easier to stop drinking because the drive to continue is reduced.

Research shows that people taking naltrexone:

• Drink fewer drinks per drinking occasion

• Have fewer heavy drinking days

• Find it easier to stop after one or two drinks

• Experience reduced cravings between drinking occasions

Naltrexone is taken as a daily 50mg tablet or can be taken an hour before drinking occasions. It doesn't make you sick if you drink, and it doesn't require abstinence to be effective. For people attempting controlled drinking, it can be a valuable tool.

The medication is most effective when combined with behavioral support. Programs like Choose Your Horizon combine naltrexone prescriptions with coaching to address both the biological and behavioral aspects of changing drinking patterns.

Our article on how naltrexone helps you regain control explains the medication in more detail.

When Abstinence Is the Better Choice

All that said, controlled drinking isn't right for everyone. In some cases, abstinence is clearly the better path.

Abstinence is generally recommended if:

• You have a history of severe alcohol use disorder

• You've tried moderation multiple times without success

• You experience physical withdrawal symptoms

• You have alcohol-related health problems

• You find that one drink always leads to more

• Drinking causes significant problems even at low levels

• Mental peace comes from not having to manage limits

For many people with significant alcohol problems, abstinence is actually easier than moderation. Not drinking at all removes the mental energy required to constantly monitor and limit intake. The question isn't "can I control my drinking?" but "is this how I want to spend my mental energy?"

Taking the Next Step

Controlled drinking is possible for some people, particularly those with milder alcohol problems and shorter drinking histories. Approaching moderation systematically with clear limits, tracking, and accountability increases the chance of success. Medication like naltrexone can make achieving and maintaining controlled drinking significantly easier.

If you want to explore whether controlled drinking could work for you, or if you want medication support for your moderation goal, take the online Alcohol Use Assessment to see if naltrexone could help.